Amphotericin (AmBisome, Abelcet, Fungizone)

Type of Medication: Antifungal

Indications: Systemic fungal infections. Oral candidiasis

Side Effects: Parenteral treatment associated with anorexia, nausea, vomiting, diarrhoea, epigastric pain, febrile reactions, headache, muscle or joint pain, renal impairment, hypokalaemia, hypomagnesaemia, arrhythmias, blood disorders, neurological disorders.abnormal LFTs, thrombophlebitis, anaemia, anuria, hypotension, malaena, rash, pruritus, hearing loss, vertigo, blurred vision, peripheral neuropathy, convulsions.

Adult dose

Route of administration: Adult (Intravenous)

Dose:Ambisone: Test dose of 1 mg over 10 min then 1 mg/kg daily as a single dose. Gradually increase to 3 mg/kg if necessary.

Administration: Ambisone: Amphotericin encapsulated in liposomes is expensive and is reserved as second line. 50 mg vial reconstituted with 12 ml water to make a solution 4 mg/ml. Add to infusion fluid (0.2-2mg/ml). Infuse required dose over 30 to 60 min. Incompatible with sodium chloride or other electrolyte solutions

Route of administration: Adult (Intravenous)

Dose:Fungizone: Test dose of 1mg over 20-30minutes then 250 mcg/kg daily, increasing if tolerated to 1mg/kg/day. Prolonged treatment is usually necessary

Administration: Fungizone: Reconstitute each vial with 10ml WFI and shake, then dilute futher in Dextrose 5% to make concentration not greater than 100 mcg/ml.. Protect from light. Flush with dextrose 5% or use separate line.

Route of administration: Adult (Nebulised)

Dose:25 mg in 6 mls bd for 10 days. (Assess respiratory function before and after first dose)

Administration: Ambisone 50 mg phial. Add 12 mls sterile water. Shake vigorously for 1-2 minutes. Preparation will froth and allow to stand. Store in fridge. Swill solution gently. Syringe gently into nebuliser to avoid too much frothing. Vent outside.

Route of administration: Adult (Oral)

Dose:Suck 1 lozenge 4 times a day for oral candidiasis

Administration: Use after meals

Paediatric dose

Route of administration: Paediatric (Intravenous)

Dose:Fungizone: Test dose of 12.5 mcg/kg over 20-30minutes then 250 mcg/kg daily, increasing if tolerated to 1mg/kg/day. Prolonged treatment is usually necessary

Examples of some Drug Interactions

Interacting drug: Aminoglycosides

increased risk of nephrotoxicity

Interacting drug: Corticosteroids

increases risk of hypokalaemia.

Interacting drug: Digoxin

increased toxicity with hypokalaemia

Interacting drug: Tacrolimus, Cyclosporin

increases risk of nephrotoxicity